摘要
目的:探讨膜诱导技术治疗胫骨感染性骨缺损的临床疗效。方法:回顾性分析2017年1月至2020年1月收治的42例胫骨感染性骨缺损的患者。其中男33例,女9例,年龄17~64岁,平均年龄(41.4±13.9)岁。根据Cierny-Mader分型,Ⅲ型11例,Ⅳ型31例。治疗分两个阶段进行,第一阶段清创并植入抗生素骨水泥诱导成膜,清创后骨缺损长度3.7~17.0 cm,平均(8.8±3.7)cm。第二阶段感染控制后取自体髂骨及同种异体骨行膜内骨移植修复骨缺损。两个阶段均采用内固定固定骨断端。术后通过观察临床表现及抽血检查感染指标判断感染控制情况,定期进行X线检查了解骨愈合情况。采用下肢功能量表(LEFS)评分评价下肢功能恢复情况。结果:本组42例患者随访13~36个月,平均随访(21.6±6.7)个月。第一阶段手术次数1~4次,平均(1.3±0.8)次,皮瓣覆盖22例,5例皮瓣部分坏死后再次行筋膜皮瓣或游离植皮治愈;第二阶段术后感染复发5例,4例经再次清创后感染控制,3例再次行第二阶段手术治疗,1例清创后行骨搬移治疗。1例清创后感染再次复发,患者要求截肢治疗。其余所有患者都获得了骨性愈合,骨愈合时间4~13个月,平均(6.6±1.9)个月。末次随访时LEFS评分30~80分,平均(68.8±11.4)分,高于术前的(52.6±18.1)分,且差异有统计学意义(t=5.804,P<0.001),表明下肢功能明显改善。结论:膜诱导技术治疗胫骨感染性骨缺损疗效确切,手术并发症相对较少。
Objective:To investigate the clinical efficacy of induced membrane technique in the treatment of infective bone defect of the tibia.Methods:A total of 42 patients with tibial infected bone defects treated from January 2017 to January 2020 were retrospectively analyzed.There were 33 males and 9 females with a mean age of(41.4±13.9)years(range,17-64).According to Cierny Mader classification,there were 11 cases of typeⅢand 31 cases of typeⅣ.All patients underwent two stages of surgery.In the first stage,debridement was performed and antibiotic bone cement was implanted to induce membrane formation.The mean length of bone defect after debridement was(8.8±3.7)cm(range,3.7-17.0 cm).In the second stage,the bone cement spacer was removed,autogenous iliac bone and allogeneic bone were inserted into bone defects.Internal fixation was used in both stages.The infection control was determined by clinical manifestations and blood test,and the bone healing was detected by X-ray.Lower extremity function scale(LEFS)was used to evaluate the recovery of lower limb function.Results:The mean duration of follow-up was(21.6±6.7)months(range,13-36 months)in the 42 patients.The number of operations in the first stage was 1-4 with an average of 1.3±0.8,skin flaps were covered in 22 patients,and 5 patients were cured by fasciocutaneous flap or free skin grafting.In the second stage,postoperative infection recurred in 5 patients and was controlled after debridement in 4 patients.Bone grafting was conducted again in 3 patients.One patient received bone transport after debridement.One patient required amputation after infection recurred.Bony union was achieved in the other patients,and mean healing time was(6.6±1.9)months(range,4-13 months).The mean LEFS was 68.8±11.4(range,30-80)at the last follow-up,which was significantly higher than preoperative one(52.6±18.1,t=5.804,P<0.001).Conclusions:Induced membrane technique is effective in the treatment of infective bone defect with less complications and shorter bone healing time.
作者
陈星宇
徐永清
杨晓勇
张曦娇
岳正华
何晓清
李军
石健
CHEN Xingyu;XU Yongqing;YANG Xiaoyong;ZHANG Xijiao;YUE Zhenghua;HE Xiaoqing;LI Jun;SHI Jian(Institute of Orthopaedic and Trauma,920 Hospital,Joint Logistics Support Force of the CPLA,Kunming 650032,China)
出处
《中华骨与关节外科杂志》
2022年第3期196-201,共6页
Chinese Journal of Bone and Joint Surgery
基金
云南省创伤骨科临床医学中心项目(ZX20191001)
联勤保障部队第九二〇医院科技计划发展项目(2019YGB07)。
关键词
膜诱导技术
骨髓炎
感染性骨缺损
胫骨
内固定
Induced Membrane Technique
Osteomyelitis
Infected Bone Defect
Tibia
Internal Fixation
